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Best Revenue Cycle Management (RCM) Products

Best Revenue Cycle Management (RCM) Products

Optimizing revenue cycle processes equals a $9.5B total opportunity.

Revenue cycle management is integral to creating a financially solvent health system. However, embedded in the current process for managing the healthcare revenue cycle are many time-consuming manual processes that contribute to high administrative costs. Revenue cycle stages of securing prior authorization and financial clearance, improving clinical documentation, assigning proper codes, and managing denied claims require substantial labor resourcing. Doing these tasks manually can result in staff burnout and costly errors throughout a patient's care.

Additionally, today’s market presents many challenges—higher costs and deductibles, decreasing reimbursements, more regulatory complexity, shifting payment models, and increasing consumerism. To deal with these financial pressures, health systems are being forced to innovate.

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Revenue Cycle Management (RCM): Products


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45 products
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Versatile platform
Versatile platform
Versatile platform
Versatile platform

HealthNautica’s eORders™, software is a comprehensive, easy-to-use, cloud solution for managing the entire perioperative process and surgical scheduling without changing your scheduling system. It begins with the physician’s office filling out an online surgery scheduling or procedure request.

Gone are the days of illegible, incomplete, inaccurate faxes sent back and forth between the physician’s office and the facility’s scheduling department. The cumbersome and error prone faxing process is replaced by an electronic form that is configured to each facility’s exact specifications and reacts to the user’s input thereby assisting the physician’s office in getting it right the first time.

All orders are legible, complete, screened for CMS Medical Necessity, incorporate SCIP, VTE, SSI and ACS NSQIP measures, verified for insurance eligibility, pre-certified and satisfy edits by CMS, commercial payers and the facility. Our solution ensures efficient surgery center scheduling and block time management while streamlining processes such as prior authorization.

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Leading Health System
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Leading Health System
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Leading Health System
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Leading Health System
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Versatile platform
Versatile platform
Versatile platform
Versatile platform

Processing incoming records and referrals is often a time-consuming, error-prone, manual task that is further challenged by high turnover and resistance to change.

Titan Intake's AI-powered platform is a superpower that enables intake teams to process 100% of incoming records 10X faster with zero change in provider behavior.

Additionally, Titan instantly keeps patients and referring providers in the loop while capturing valuable real-time operational and marketing data.

Here's a peek at Titan Intake's workflow:

  1. Intercept 100% of records, regardless of format or source
  2. Automatically identify and sort by document type
  3. Instantly extract all relevant data
  4. Update or create patient records with no transcription
  5. Keep providers and patients in the loop with zero effort
  6. Analyze real-time operational and marketing data

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Leading Health System
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Leading Health System
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Leading Health System
Health system
Leading Health System
Health system
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Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business

ReferralMD delivers AI-powered solutions for Referral Management, eConsults, Appointment Management, Fax Management, Patient Scheduling, Intake and Communications, Marketing CRM and Analytics. Our solutions help hospitals, health systems, networks, and payers streamline the referral process, decrease patient leakage, and improve communication between providers and patients. The enterprise platform’s powerful workflow automation tools help healthcare providers drive operational efficiencies, increase revenue, and improve customer service. To learn more about ReferralMD, please visit www.getreferralmd.com..

>>> HOW WE HELP <<<

Digital Front Door

  • Patient Access Tools
  • Patient Direct Scheduling
  • SmartCHAT Patient Intake
  • Patient Communications

Operations

  • Consult Management
  • Referral Management
  • Appointments and Scheduling
  • AI Fax Management

Marketing & Services

  • Marketing CRM
  • Advanced Analytics
  • Professional Services
  • SmartEXCHANGE Integrations

>>> WHO WE HELP <<<

Health Systems/ACOs/DSRIPs/CINs

  • Reducing patient leakage through SmartMatch decision support and real-time analytics
  • Standardizing and streamlining the referral management process across the organization
  • Driving operational efficiencies and allowing referral teams to scale more efficiently

PCPs/FQHCs/Dental Practices

  • Matching patients with appropriate providers using SmartMatch decision support
  • Closing the feedback loop with specialists and reducing phone calls and faxes
  • Increasing patients LTV to ensure they are not lost to competitors after referrals are sent

Specialty Care Organizations

  • Increasing referral volume and capturing more revenue using CRM and marketing tools
  • Improving customer service with referring providers through automated status reports
  • Managing referral network and gaining insight into referral patterns using analytics 
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Leading Health System
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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5+ years in business
5+ years in business
5+ years in business
5+ years in business

Hand-off Referrals to Artera

Artera Referrals creates automated, omnichannel referral outreach to modernize the care experience and eliminate manual referral management.

Drive Results with Referral Templates

Rapidly deploy personalized referral outreach by using turn-key, leading practice conversation templates.

  • Automatically receive referrals from the EHR to trigger referral outreach from a known number on the patient’s preferred communication channel
  • Customize outreach and manage message fatigue with messaging rules that abide by TCPA hours
  • Reduce call center overload and increase referral conversions with throttling to improve referral conversion

Uncover Insights & Improve Efficiency

Less than half of providers have data needed to understand their own referrals.

  • Access comprehensive reports on referral management and conversions
  • Track analytics to understand workflow performance, engagement, and revenue outcomes
  • Monitor outreach performance and uncover opportunities for higher conversions

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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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5+ years in business
5+ years in business
5+ years in business
5+ years in business

Interactive notifications let patients know when they've been referred, book, and get real-time confirmation. Patients can receive automated reminders to finish scheduling a referral on a cadence, depending on the organization's workflows and needs. Patient bookings are integrated directly with the EHR schedule, and providers can be notified when a patient completes scheduling.

Increase rates of referral conversion to completed appointments, cut out the phone tag for staff, and streamline patient acquisition with self-service opportunities for patients.

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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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Versatile platform
Versatile platform

Mother Goose Health is a leading innovator in maternity care, dedicated to transforming the landscape of maternal health through a fully integrated care management platform. By leveraging cutting-edge data and technology, we enhance the quality, efficiency, and accessibility of maternity care.

Our platform provides a comprehensive solution that:

  • Empowers Patients and Providers: By harnessing advanced data analytics and real-time insights, we enable personalized and equitable care delivery, ensuring that both patients and healthcare providers are well-supported throughout the maternity journey.
  • Improves Care Outcomes: Our technology enhances healthcare access and delivery, leading to improved clinical outcomes, reduced complications, and optimized care experiences.
  • Boosts System Efficiency: We streamline care processes and integrate systems to improve operational efficiency, reduce costs, and eliminate redundancies in the care continuum.
  • Promotes Scalable Solutions: Our platform is designed to scale effectively, making high-quality maternity care accessible to diverse populations across various settings.

At Mother Goose Health, we are committed to driving transformative progress in maternal health, partnering with healthcare providers, payers, and other stakeholders to build a more resilient and effective healthcare ecosystem.

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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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5+ years in business
5+ years in business
5+ years in business
5+ years in business

The EMR-agnostic referral management solution is easily accessible via web-based portal. Care teams, staff, specialists, and referral coordinators can create, track, and schedule referrals at point of care. Stakeholders can push referral orders into EMRs in real-time, courtesy bi-directional HL7/FHIR API powered interface. In addition to EMR integrations, it also simplifies the process to auto-populate information from referral order fax by running OCR application and live insurance verification using Change Healthcare integration ensuring quick turnaround time in filling referral forms. It helps to choose best-suited specialists with filters for cost and quality metrics, in-and out of network providers, insurances accepted, languages spoken, distance filter etc. 

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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Product that allows various parties in a health system to screen and connect patients with the appropriate community-based organizations, closing the loop with those organizations on the background. Core product centered around the HealtheRX, which allows the results of a patient screen to curate a specific set of identified resources within that health system's network.
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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5+ years in business
5+ years in business
5+ years in business
5+ years in business

PH Capture™ provides a simple solution to this problem with a streamlined, paperless, customized workflow that reduces labor costs and lowers overall operational costs. Our solution converts faxes into HIPAA-compliant electronic files that can be managed and shared online-- eliminating the paper-shuffling, copying and scanning. Each workflow is customized to your department, even down nomenclature.

PH Capture will integrate with the organization/practices’ EHR, and electronic files can be exported directly into the patient’s record.

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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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Versatile platform
Versatile platform
5+ years in business
5+ years in business
Versatile platform
Versatile platform
5+ years in business
5+ years in business

PH Connect enables communication and collaboration community-wide, across the entire healthcare continuum; from front-end primary care providers, urgent care centers, and athletic trainers; through the ED, specialists, and hospitalists; all the way through to the post-acute home health, rehab, and long-term care providers. 

Like all Proficient Health solutions, PH Connect streamlines access, improves the direct admission process, and makes referrals easier and more efficient. Duplicate tests, unnecessary diagnostics, and unnecessary hospital stays can also be avoided. All of this leads to better patient care, increased overall productivity, and satisfaction of physicians and other staff, and widespread user adoption. 

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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
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Buyer's Guide


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A Buyer's Guide to

Revenue Cycle Management (RCM)

What is digital in revenue cycle management?
Digital RCM solutions are software platforms and technologies that automate and optimize the healthcare revenue cycle. These tools leverage advanced algorithms, artificial intelligence, and data analytics to streamline financial processes, improve efficiency, reduce errors, and provide actionable insights.

Solution framework

Front-end
Credentialing Systems that verify and assess the qualifications, experience, and professional background of healthcare providers to ensure they meet the standards required to practice within a specific healthcare organization or network.
Insurance eligibility verification and prior authorization Systems that confirm a patient’s insurance coverage, benefits, and obtain approval from the insurance provider for specific medical procedures or treatments before they are performed.
Price transparency and cost estimation Systems that provide clear, accessible information about the costs of healthcare services to patients, including estimated out-of-pocket expenses, and facilitating various payment options to improve financial clarity and patient satisfaction.

*Scheduling and Pre-Registration are crucial parts of the Front-End Revenue Cycle process. Please see our Digital Front Door categories for companies in the Scheduling and Pre-Registration space.


Mid-cycle
Clinical documentation integrity Systems that ensure patient medical records are accurate, complete, and properly reflect the patient’s condition, treatments, and outcomes to support quality care, appropriate reimbursement, and regulatory compliance.
Medical coding Systems that translate medical diagnoses, procedures, and equipment into universal alphanumeric codes based on standardized coding systems (e.g., ICD-10, CPT) for accurate billing and reporting.


Back-end
Claims management Systems that prepare, submit, track, and resolve healthcare claims with insurance payers to ensure timely and accurate reimbursement for services provided.
Denials and appeals management Systems that identify, analyze, and address denied claims, including the process of appealing incorrect denials to maximize reimbursement and improve future claim submission accuracy.
Patient billing and payment collection Systems that generate accurate patient bills, communicate financial responsibilities, offer payment options, and collect payments for healthcare services rendered.
Revenue cycle analytics and intelligence Systems that use data analysis tools and techniques to gain insights into the revenue cycle performance, identify trends, predict outcomes, and make data-driven decisions to optimize financial performance and operational efficiency.

Transforming revenue cycle management (RCM) through digital innovation is no longer just a back-office necessity; it’s a strategic imperative for healthcare organizations. By leveraging advanced RCM solutions, organizations can not only reduce administrative burdens and improve cash flow but also elevate the patient financial experience. A seamless, data-driven revenue cycle empowers healthcare providers to reinvest in their mission, delivering higher-quality care, expanding access, and driving sustainable growth in an increasingly complex environment.
Amberly Diets
— Beth Konczakowski
Director of Strategic Advisory Services

The case for digital in revenue cycle management

Healthcare systems today face numerous challenges that impact their financial stability and operational efficiency through increasing complexity of reimbursement models, rising costs, and growing patient financial responsibility. In this landscape, digital solutions for revenue cycle management have the potential to address these issues and optimize healthcare financial operations.

Key drivers for digital in RCM

Financial performance
One of the most pressing concerns in healthcare is maintaining financial stability while delivering high-quality care. Many healthcare organizations struggle with narrow margins and financial pressures with the average operating margin for hospitals performing at a loss of 13.5% in 2022. 1 Effective RCM addresses this challenge by streamlining revenue capture, reducing claim denials, and accelerating cash flow. By implementing robust RCM solutions, healthcare organizations can improve their financial performance, ensure proper reimbursement for services rendered, and maintain the resources necessary to provide excellent patient care.
Administrative burden
Administrative costs in healthcare have reached unsustainable levels, accounting for 15-25% of total healthcare spending in the United States. 2 Much of the administrative load falls on clinical staff, contributing to burnout and job dissatisfaction. RCM solutions offer a way to alleviate this burden by automating many administrative tasks related to billing, coding, and claims processing. Through intelligent automation and workflow optimization, RCM not only improves operational efficiency but also has the potential to enhance job satisfaction and retention among healthcare professionals.
Patient financial experience
As patient financial responsibility continues to grow, with out-of-pocket costs rising exponentially year-over-year, healthcare organizations face increasing pressure to provide a transparent and consumer-friendly financial experience. 3 Traditional billing practices often lead to confusion, frustration, and ultimately, lower collection rates. RCM solutions address this by offering patient-centric billing options, unified billing, clear cost estimates, and flexible payment plans. By improving the patient’s financial journey, healthcare organizations can increase patient satisfaction, boost collection rates, and build long-term patient loyalty.
Regulatory compliance
Healthcare organizations operate in a highly regulated environment, with complex rules governing billing, coding, and reimbursement. Non-compliance can result in significant financial penalties and reputational damage. The total cost for non-compliance is currently deemed greater than $14M. 4 RCM solutions help organizations navigate this regulatory landscape by embedding compliance checks into workflows, automating documentation for audits, and staying up-to-date with changing regulations. This proactive approach to compliance not only reduces risk but also improves the accuracy and efficiency of the revenue cycle.

Key attributes of revenue cycle management solutions

Effective Revenue Cycle Management solutions share several critical attributes that enable them to optimize financial performance and enhance operational efficiency. When evaluating RCM solutions, healthcare organizations should look for the following key characteristics:

End-to-end coverage
  • Manages the entire revenue cycle from patient scheduling to final payment
  • Complements existing practice management systems to streamline financial operations
  • Provides a unified platform for all revenue cycle functions
Example: An RCM ecosystem that handles scheduling, eligibility verification, coding, billing, and collections within a single integrated platform.
Intelligent automation
  • Utilizes AI and machine learning to automate routine tasks
  • Employs robotic process automation (RPA) for repetitive, rule-based processes
  • Reduces manual data entry and associated errors
Example: An RCM solution that automatically codes encounters based on clinical documentation and updates claims in real-time.
Advanced analytics and reporting
  • Offers real-time financial dashboards and key performance indicators
  • Provides predictive analytics for denials management and cash flow forecasting
  • Enables drill-down capabilities for detailed analysis of revenue cycle performance
Example: A system that predicts which claims are likely to be denied and suggests preemptive actions to prevent denials.
Patient-centric financial experience
  • Offers clear, upfront cost estimates and explanations of benefits
  • Provides multiple payment options and flexible payment plans
  • Enables self-service portals for patients to manage their accounts
Example: A patient portal that allows individuals to view their bills, set up payment plans, and make payments online or via mobile app.
Compliance and security
  • Ensures adherence to healthcare regulations (e.g., HIPAA, HITECH)
  • Provides robust data security measures to protect sensitive financial information
  • Offers audit trails and reporting for compliance monitoring
Example: An RCM system with built-in compliance checks that flag potential regulatory issues before claims are submitted.
Real-time eligibility and benefits verification
  • Performs instant insurance eligibility checks
  • Provides detailed breakdowns of patient benefits and coverage
  • Updates patient financial responsibility in real-time
Example: An RCM tool that automatically verifies insurance coverage when appointments are scheduled and updates information at check-in.
Denial management and prevention
  • Identifies root causes of denials through pattern analysis
  • Offers workflow tools for efficient denial follow-up and appeals
  • Provides education and training to prevent future denials
Example: A denial management module that categorizes denials, assigns them to appropriate staff, and tracks appeal outcomes.
Continuous performance improvement
  • Benchmarks performance against industry standards
  • Identifies areas for process improvement and cost reduction
  • Provides ongoing training and support for optimal system utilization
Example: An RCM system that compares an organization’s key metrics to peer benchmarks and suggests improvement strategies.

Organizing for success with revenue cycle management

To successfully implement Revenue Cycle Management solutions, health systems must consider several key factors. By keeping these principles in mind, organizations can effectively optimize their revenue cycle operations and achieve financial goals.
  • Conduct a comprehensive revenue cycle assessment
    1. Analyze current performance metrics across all stages of the revenue cycle
    2. Identify pain points, inefficiencies, and opportunities for improvement
    3. Benchmark performance against industry standards and best practices
  • Optimize existing technology and processes
    1. Assess current RCM technology for underutilized features and potential upgrades
    2. Identify and address user issues regarding existing systems
    3. Explore opportunities for automation and improvement within existing systems to maximize efficiency with current and new technologies
  • Invest in staff training and change management
    1. Provide comprehensive training on new RCM systems and processes
    2. Educate all staff on the importance of accurate documentation and coding
    3. Offer ongoing education to keep staff updated on best practices and regulatory changes
    4. Encourage open communication about revenue cycle challenges and solutions
    5. Recognize and reward staff contributions to revenue cycle improvement
  • Establish key performance indicators (KPIs) and monitoring processes for continuous improvement
    1. Define clear, measurable KPIs for each stage of the revenue cycle
    2. Use analytics tools to identify trends, patterns, and opportunities for improvement
    3. Implement data-driven decision-making processes across the revenue cycle
    4. Regularly review and act on insights generated from RCM analytics
  • Optimize front-end processes
    1. Implement robust patient registration and eligibility verification processes
    2. Develop clear financial counseling protocols for patients
    3. Establish processes for accurate charge capture and coding at the point of service
  • Stay current with regulatory changes and industry trends
    1. Establish processes for monitoring and implementing regulatory updates
    2. Participate in industry associations and conferences to stay informed of best practices
    3. Regularly evaluate new technologies and solutions that could enhance RCM performance
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